Majority of new onset of dental caries occurred from caries-free students: A longitudinal study in primary school students

Taro Kusama, Hidemi Todoriki, Ken Osaka, Jun Aida

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


We examined Rose’s axiom that a large number of people exposed to a small risk may generate more cases than a small number exposed to a high risk, using data on caries incidence. This longitudinal study was based on the records of annual dental checks conducted in primary schools in Okinawa, Japan. Participants were students aged 6–11 years at baseline in 2014, and a follow-up survey was conducted after one-year. The outcome variable was the increased number of decayed, missing, and filled teeth (DMFT). The predictor variable was the baseline DMFT score. Gender, grade, and affiliated school variables were adjusted. A negative binomial regression model was used to obtain the estimated increase of DMFT score. Among 1542 students, 1138 (73.8%) were caries-free at baseline. A total of 317 (20.6%) developed new caries during the follow-up. The predicted number of new carious teeth in a caries-free students and students with DMFT = 1 at baseline were 0.26 (95% CI, 0.22–0.31) and 0.45 teeth (95% CI, 0.33–0.56), respectively. However, among the total of 502 newly onset of carious teeth, 300 teeth (59.7%) occurred from the caries-free students at baseline. Hence, prevention strategies should target the low-risk group because they comprise the majority of the population.

Original languageEnglish
Article number8476
Pages (from-to)1-9
Number of pages9
JournalInternational journal of environmental research and public health
Issue number22
Publication statusPublished - 2020 Nov 2


  • Dental caries
  • Longitudinal study
  • Population approach
  • Prevention paradox
  • Universal health coverage

ASJC Scopus subject areas

  • Pollution
  • Public Health, Environmental and Occupational Health
  • Health, Toxicology and Mutagenesis


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